Measles and rubella elimination country profile: Montenegro

Measles elimination status Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/6thRVC Rubella elimination status Total population 626 101 < 1 year old 7 130 < 5 years old 35 821 Demographic information, 2016 Source: World Population Prospects: The 2015 Revision, New York, United Nations National plan of action Does the country have a national plan of action? ND Is it updated? ND Source: Measles and rubella elimination Annual Status Update report, 2016 Measles and rubella elimination country profile Montenegro Measles and rubella immunization schedule, 2016 Source: Immunization schedule, WHO, Data and Statistics, Immunization Monitoring and Surveillance (http://www.who.int/immunization/monitoring_surveillance/data/en/) MMR = measles-mumps-rubella-containing vaccine; MCV1 = first dose measles-containing vacccine; MCV2 = second dose measles-containing vaccine; RCV = rubella-containing vaccine Measles and rubella cases and immunization coverage, 2007–2016 Source: Disease incidence and immunization coverage, WHO, Data and Statistics, Immunization Monitoring and Surveilance (http://www.who.int/immunization/monitoring_surveillance/data/en/) MCV1 = first dose of measles-containing vaccine MCV2= second dose of measles-containing vaccine Confirmed measles cases by month of onset, 2012-2016 Source: CISID2 2016 Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/6thRVC Source: Measles and rubella elimination Annual Status Update report, 2016 Definition used for an outbreak 2015 interrupted 2016 eliminated 2015 interrupted 2016 eliminated 0 10 20 30 40 50 60 70 80 90 100 0 1 2 3 4 5 6 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Measles Rubella Coverage MCV1 Coverage MVC2 0 1 2 3 4 5 6 7 8 9 J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D 2012 2013 2014 2015 2016 As Montenegro is in the measles and rubella elimina- tion phase, “classic” definition of an outbreak is not applicable, as at least two epidemiologically linked measles or rubella cases in this phase of containment of these diseases are considered as an outbreak    Vaccine Schedule MCV1 MMR 13 months MCV2 MMR 6 years Year of introduction MCV2 1994 RCV 1994 Measles vaccination in school Yes Suspected measles cases Confirmed measles cases Discarded as non- measles Measles incidence Genotypes detectedLabora- tory Epi- linked Clincally Total 2012 0 0 0 0 0 0 0 NA 2013 10 0 0 0 0 10 0 NA 2014 65 7 0 ND 7 60 6.5 ND 2015 19 13 2 0 15 4 16 ND 2016 3 0 0 0 0 3 0 NA Measles incidence, epidemiologic and virologic characteristics, 2012-2016 Measles surveillance and laboratory performance indicators, 2012-2016 Source: Measles and rubella elimination Annual Status Update report, 2012-2016 Incidence calculated per 1 million population ND = Data not available; NA= Not applicable Source: ASU 2012-2016, MeaNS 2012-2016 and laboratory accreditation results 2012-2016 ND = Data not available; NA= Not applicable A proficient laboratory is WHO accredited and/or has an established quality assurance programme with oversight by a WHO accredited laboratory Rubella incidence, epidemiologic and virologic characteristics, 2012-2016 Rubella surveillance and laboratory performance indicators, 2012-2016 Source: Measles and rubella elimination Annual Status Update report, 2012-2016 Incidence calculated per 1 million population ND = Data not available; NA= Not applicable Source: ASU 2012-2016, RubeNS 2012-2016 and laboratory accreditation results 2012-2016 ND = Data not available; NA= Not applicable A proficient laboratory is WHO accredited and/or has an established quality assurance programme with oversight by a WHO accredited laboratory Surveillance performance indicators and targets a. Rate of discarded cases: at least 2 discarded measles or rubella cases per 100 000 population b. % cases with adequate laboratory investigation: ≥ 80% c. % origin of infection known: ≥ 80% d. Rate of viral detection: ≥ 80%  Measles and rubella elimination country profile Montenegro Discarded non- measles rate % 1st sub- national unit with ≥ 2 discarded cases % cases with adequate laboratory investiga- tion % origin of infection known # specimen tested for measles % positive for measles Rate of viral detection % WHO and proficient labs 2012 4 ND 100% NA ND ND ND ND 2013 1.6 33.3% 100% NA ND ND NA ND 2014 0.8 19% 91.6% 100% 7 0% 0 ND 2015 9.5 9.5% 100% 100% 19 79% 0 0% 2016 4.8 30.4% 100% NA 30 0% NA 0% Suspected rubella cases Confirmed measles cases Discarded as non- rubella Rubella incidence Genotypes detected Laboratory Epi- linked Clincally Total 2012 0 0 0 0 0 0 0 NA 2013 7 0 0 0 0 7 0 NA 2014 7 0 0 0 0 7 0 NA 2015 8 0 0 0 0 8 0 NA 2016 0 0 0 0 0 0 0 NA Discarded non- rubella rate % 1st sub- national unit with ≥ 2 discarded cases % cases with adequate laboratory investiga- tion % origin of infection known # specimen tested for rubella % positive for rubella Rate of viral detection % WHO and proficient labs 2012 5.3 ND 100% NA ND ND ND ND 2013 1.1 33.3% 100% NA ND ND NA ND 2014 1.1 19% 100% NA 0 0% 0 ND 2015 1.3 14.3% 100% NA 8 0% 0 0% 2016 12.9 73.9% 100% NA 72 0% NA 0% RVC comments, based on 2016 reporting The Regional Verification Commission for Measles and Rubella Elimination (RVC) concluded that endemic transmission of both measles and rubella remained interrupted in Montenegro in 2016. Considering the RVC’s conclusions about the interrupted status of measles and rubella transmission in the country in 2014 and 2015, it is pleased to declare that Montenegro has achieved elimination of measles and rubella. Efforts to reach and immunize the at-risk Roma population are recognized and endorsed. However, the RVC emphasizes that laboratory testing of specimens from suspected cases should be routinely performed at WHO-accredited laboratories or laboratories of known proficiency, and acknowledges with satisfaction that work is in progress to establish a national measles and rubella reference laboratory. The RVC is also concerned about the continuing decline in vaccination coverage resulting in a dangerously large accumulation of susceptible children across the country, which presents a high risk for re-establishing endemic transmission. The RVC urges the national health authorities and public health system to consider all additional activities, in line with WHO guidelines, to address these issues. Source: Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report (www.euro.who.int/6thRVC) ©WHO 2018 Measles and rubella elimination country profile Montenegro ©WHO 2018 Information on CRS, 2016 No cases reported Source: Measles and rubella elimination Annual Status Update report, 2016 CRS = congenital rubella syndrome Supplementary immunization activities Year Target age Vaccine used % Coverage 2016 0-12 Y MMR 30.3 2016 0-12 Y MMR 68.4 NA Source: Supplementary immunization activities, WHO, Data and Statistics, Immunization Monitoring and Surveillance NA= Not applicable; MMR = measles-mumps-rubella vaccine